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Hypertensive black men who got health education and monitoring along with a haircut from their barbers were able to achieve better blood pressure control, according to data from a two-year randomized intervention study.

The study, involving more than 1,000 men who patronized 17 black-owned barbershops in Dallas County, Texas, from March 2006 to December 2008, found that almost 10% more of them achieved predefined blood pressure levels with free monitoring and encouragement for physician follow-up compared with those who received only educational pamphlets.

The nonblinded barbershop intervention resulted in a trend toward lower systolic blood pressure, reflected in an absolute difference of 2.5 mm Hg compared with the control group, reported Ronald G. Victor, MD, of the University of Texas Southwestern Medical Center in Dallas, and colleagues.

The results suggest an intriguing public health opportunity, Victor and colleagues concluded in an article published online in Archives of Internal Medicine.

"The data add to an emerging literature on the effectiveness of community health workers in the care of people with hypertension," the researchers wrote in conclusion.

"Contemporary barbers constitute a unique workforce of community health workers whose historical predecessors were barber-surgeons," they added.

An estimated 70% of hypertensive black men have blood pressure that exceeds recommended levels (Hypertension 2008; 52: 818-827). The CDC has assigned priority status to the development of novel hypertension outreach programs to deliver messages that resonate with black men, the authors wrote in the introduction to their findings.

Traditionally, black churches have partnered with the medical community as conduits of medical outreach, but fewer black men attend church than do black women, the authors noted. Black-owned barbershops have special appeal for community-based interventions because of their status as a cultural institution that draws a large and loyal male clientele, providing a comfortable discussion forum for numerous issues -- including healthcare.

Barbershop-based hypertension outreach programs have become increasingly common, wrote Victor and co-authors. Whether the programs improve hypertension control among black men has remained unclear, however.

The authors conducted a randomized controlled trial to assess the potential for barbershop outreach programs to effect better blood pressure control among hypertensive black men. All black male patrons of the 17 Dallas County barbershops were offered baseline blood pressure screening for hypertension.

Screening criteria included self-reported use of prescription blood pressure medication, a blood pressure higher than 135/85 mm Hg for men without self-reported diabetes, or a pressure greater than 130/80 mm Hg for diabetics, the investigators explained.

After the baseline period, barbershops were randomized to distribute pamphlets about hypertension as a control group or to act as an intervention group, where barbers continually offered blood pressure checks to all male customers and dispensed sex-specific messages about blood pressure control.

The barbers in the intervention group discussed blood pressure control and encouraged their customers to seek follow-up evaluation from physicians. Messages also were conveyed through the use of wall posters showing actual barbershop customers involved in hypertension treatment-seeking behaviors.

Hypertensive black men identified through screening received identical treatment prior to randomization of the barbershops.

The nine barbershops were randomized to the intervention, involving 539 patrons with confirmed hypertension. The eight barbershops assigned to the control group had a total of 483 patrons with confirmed hypertension.

The evaluation period lasted 10 months, and the primary outcome was the proportion of customers in each group who achieved blood pressure control of <135/85 mm Hg (<130/80 mm Hg for diabetic men).

At baseline, 69% of the men were being treated for hypertension, and 38% of the men had blood pressure at the defined control level.

At the end of the study, the proportion of barbershop patrons with blood pressure control increased in both groups: 19.9% in intervention group and 11.1% in the control group (P<0.001). However, the intervention group had significantly greater improvement from baseline compared with the control group (P=0.03).

The authors noted several important limitations to the study. For one thing, not all barbers participated fully, and not all patrons agreed to have their BP monitored and be referred for physician follow-up. Because study sites were confined to a single county, the results cannot be generalized to other areas. Additionally, because the barbershops' clientele were predominately middle income, "the intervention had limited ability to reach very low-income individuals who will require other types of intervention," the authors wrote.

They stressed that the study "provided a snapshot of BP improvement at a point in time and does not demonstrate whether the outcomes are sustainable, particularly because financial incentives were paid to barbers for conducting the intervention and to patrons for following their advice in seeking medical attention."

Additionally, because hypertensive patrons chose their individual physicians, data could not be collected on increased antihypertensive treatment costs associated with the intervention.

But "the results of this study provide the first evidence for the effectiveness of a barber-based intervention for controlling hypertension in black men and indicate that more research is needed to develop a highly effective and sustainable intervention model prior to large-scale program implementation," the authors wrote in their discussion.

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